Braided Flange Branch Graft for Branch Vessel

ABSTRACT

A braided flange branch graft formed of a braided super elastic memory material includes a neck between an inner flange and an outer flange. The neck is positioned in a side opening in a sidewall of a main stent graft and the inner flange and outer flange are deployed on opposite sides of the sidewall. The inner flange and the outer flange have a diameter greater than a diameter of the side opening in the sidewall of the main stent graft. Thus, the sidewall of the main stent graft is sandwiched between the inner flange and the outer flange securely and simply mounting the braided flange branch graft to the main stent graft. The braided flange has a substantially unobstructed fluid communication passage therethrough. Further, when stretched into a substantially cylindrical shape for delivery, the braided flange branch graft has a small delivery profile and is extremely flexible.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an intra-vascular device and method.More particularly, the present invention relates to a device used totreat aneurysms where a branch connection from a main stent graftcrosses the ostium of a branch vessel.

2. Description of Related Art

A conventional main stent graft typically includes a radially expandablereinforcement structure, formed from a plurality of annular stent rings,and a cylindrically shaped layer of graft material defining a lumen towhich the stent rings are coupled. Main stent grafts are well known foruse in tubular shaped human vascular or other body vessel.

Endovascular aneurysmal exclusion is a method of using a main stentgraft to partially or completely isolate an aneurysmal sac from systemicblood pressure by preventing pressurized blood flow from pressurizingthe interior of an aneurysm, thereby reducing the risk of rupture of theaneurysm and the need for an invasive surgical intervention.

Illustratively, the main (body) stent graft was placed in the mainvessel, e.g., the aorta, to exclude an aneurysm. A (branch) fenestration(opening) in the side of the main body provides an opening for bloodflow to a branch vessel which would otherwise be obstructed by theposition of the main body across the ostium of the branch vessel. Abranch graft or branch stent graft was then inserted through the sideopening and into the branch vessel spanning any gap between the outsideof the branch opening in the main body and the ostium of the branchvessel, and carrying blood across the gap without pressuring theaneurysm.

Initially, the main stent graft was deployed in the main vessel suchthat an opening in the sidewall of the main stent graft was aligned withthe branch vessel. A branch graft having a silicone flange was thenpassed through the opening in the main stent graft and deployed in thebranch vessel. The silicone flange was configured to engage with andseal with the opening in the sidewall of the main stent graft. However,the silicone flange had a relatively large delivery profile and wassomewhat inflexible thus limiting the range of applications in which thesilicone flange with attached branch grafts could be used.

SUMMARY OF THE INVENTION

In accordance with one example, a braided flange branch graft formed ofa braided super elastic memory material includes a neck between an innerflange and an outer flange. The neck is positioned in an opening in asidewall of a main stent graft and the inner flange and outer flange aredeployed on opposite sides of the sidewall.

The inner flange and the outer flange have a diameter greater than adiameter of the opening in the sidewall of the main stent graft. Thus,the sidewall of the main stent graft is sandwiched between the innerflange and the outer flange securely and simply mounting the braidedflange branch graft to the main stent graft. Further, whenlongitudinally stretched into a substantially cylindrical shape fordelivery, the braided flange branch graft has a small delivery profileand is extremely flexible.

Embodiments are best understood by reference to the following detaileddescription when read in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side plan view of a braided flange branch graft inaccordance with one embodiment;

FIG. 2 is a perspective view of the braided flange branch graft of FIG.1;

FIG. 3 is a cross-sectional view outline of the braided flange branchgraft corresponding to the side plan view of FIG. 1;

FIG. 4 is a cut away cross-sectional view of a braided flange branchgraft delivery system for delivering the braided flange branch graft ofFIGS. 1 and 2 into the vasculature of a patient;

FIG. 5 is a cross-sectional view of a vessel system including thebraided flange branch graft of FIGS. 1 and 2 in its stretched shape inaccordance with one embodiment; and

FIG. 6, 7, 8 are cross-sectional views of the vessel system of FIG. 5 atfurther stages during deployment of the braided flange branch graft.

Common reference numerals are used throughout the drawings and detaileddescription to indicate like elements.

DETAILED DESCRIPTION

In accordance with one example, referring to FIG. 7, a braided flangebranch graft 100 formed of a braided super elastic memory material(e.g., nitinol) includes a neck 106 between an inner flange 102 and anouter flange 104. Neck 106 is positioned in a side opening 506 in asidewall 508 of a main stent graft 502 and inner flange 102 and outerflange 104 are deployed on opposite sides of sidewall 508. Inner flange102 and outer flange 104 have a diameter D1 greater than a diameter D3of side opening 506. Thus, sidewall 508 of main stent graft 502 issandwiched between inner flange 102 and outer flange 104 securely andsimply mounting braided flange branch graft 100 to main stent graft 502.Further, referring to FIG. 5, when stretched into a substantiallycylindrical shape for delivery, braided flange branch graft 100 has asmall delivery profile and is extremely flexible.

More particularly, FIG. 1 is a side plan view of a braided flange branchgraft 100, sometimes called a side branch, in accordance with oneembodiment. FIG. 2 is a perspective view of braided flange branch graft100 of FIG. 1. FIG. 3 is a cross-sectional view outline 300 of braidedflange branch graft 100 corresponding to the side plan view of FIG. 1.

Referring now to FIGS. 1, 2 and 3 together, braided flange branch graft100 has a longitudinal axis L. As used herein, longitudinally means in adirection parallel to longitudinal axis L. Radially means in a directionperpendicular to longitudinal axis.

Braided flange branch graft 100 includes an inner, e.g., first, flange102, and an outer, e.g., second, flange 104, a neck 106, and a trunk108.

Neck 106 is longitudinal between inner flange 102 and outer flange 104.Inner flange 102 and outer flange 104 extend radially outward from neck106. More particularly, inner flange 102 and outer flange 104 have afirst diameter D1 at outer radial perimeters 110, 112, respectively,greater than a second diameter D2 of neck 106. Accordingly, inner flange102, outer flange 104, and neck 106 collectively define an annularchannel 114.

Inner flange 102, sometimes called an inner disk, is saucer shaped inaccordance with this example. More particularly, outer radial perimeter110 of inner flange 102 is circular. Further, the thickness of innerflange 102 increases towards the radial center of inner flange 102. Toillustrate, a first thickness T1 of inner flange 102 at outer radialperimeter 110 is less than a second thickness T2 of inner flange 102 atthe point where inner flange 102 meets neck 106.

Similarly, outer flange 104, sometimes called an outer disk, is saucershaped in accordance with this example. More particularly, outer radialperimeter 112 of outer flange 104 is circular. Further, the thickness ofouter flange 104 increases towards the radial center of outer flange104. To illustrate, a first thickness T1 of outer flange 104 at outerradial perimeter 112 is less than a second thickness T2 of outer flange104 at the point where outer flange 104 meet neck 106.

Although inner flange 102 and outer flange 104 are described andillustrated as being saucer shaped, i.e., being in the shape of a diskthat increases in thickness towards the radial center of the disk, inother examples, inner flange 102 and outer flange 104 are in the shapeof a uniform thickness disk.

Trunk 108 extends longitudinally outward from outer flange 104 in adirection opposite inner flange 102. Trunk 108 includes a base 109attached to outer flange 104. In accordance with this example, trunk 108is cylindrically shaped, the cylinder having longitudinal axis L.

Extending longitudinally through braided flange branch graft 100 is alumen 116. More particularly, braided flange branch graft 100 includesan inner end 118, e.g., a first longitudinal or proximal end, and anouter end 120, e.g., a second longitudinal or distal end. An inner,e.g., first, opening 122 of lumen 116 is formed in the radial center ofinner flange 102 at inner end 118. A second opening 124 of lumen 116 isformed by the open end of trunk 108 at outer end 120. As set forthfurther below, fluid, e.g., blood, passes through lumen 116, e.g., froma main vessel into a branch vessel.

Braided flange branch graft 100 is formed of a braided super elasticmemory material, e.g., nitinol, in accordance with one example.Generally, a super elastic memory material is a memory material that canbe stretched from the shape of braided flange branch graft 100 shown inFIGS. 1 and 2 into a cylinder (see braided flange branch graft 100 ofFIG. 5 for example) without permanent deformation of the memorymaterial, i.e., the memory material will return from the cylinder to theshape of braided flange branch graft 100 shown in FIGS. 1 and 2 uponbeing released. A memory material is a material that can be set to havea specific shape, e.g., by heat setting, such that the material willreturn to the specific shape when the material is in its relaxed state.

Illustratively, the braid is made by intertwining strands of superelastic memory material, e.g., strands of nitinol. The strands are allof one type, e.g., nitinol, in one example.

In another example, two or more different types of strands are braidedtogether to form braided flange branch graft 100. Illustratively,strands of a biocompatible polymer, e.g., polyester (PE) or polyesterterephthalate (PET), are braided together with strands of a memorymetal, e.g., nitinol, to form braided flange branch graft 100. Forexample, the biocompatible polymer encourages ingrowth of thesurrounding body tissue into braided flange branch graft 100.

Illustratively, braided flange branch graft 100 is formed by heatsetting a braided super elastic memory material. For example, acylindrical shaped braid is forced over a mandrel having the shape ofbraided flange branch graft 100. In one example, the braid is clamped tothe mandrel, for example, at neck 106, to ensure conformity with themandrel. The assembly is then heat set using a conventional technique.In one embodiment the ends of braided flange branch graft 100 are fused,crimped, folded, or otherwise prevented from unravelling.

As discussed further below, braided flange branch graft 100 is stretchedinto a substantially cylindrical shape. Upon being released, braidedflange branch graft 100 returns to its relaxed state as illustrated inFIGS. 1 and 2.

In another example, referring now to FIG. 1, braided flange branch graft100 includes an elastic cover 126 illustrated by the dashed line.Illustratively, cover 126 is a super elastic material that conforms tothe stretched and relaxed shape of the braided super elastic memorymaterial of braided flange branch graft 100. Illustratively, cover 126is elastic polytetrafluoroethylene (PTFE) over a nitinol braid.

FIG. 4 is a cross-sectional view of a braided flange branch graftdelivery system 400 for delivering braided flange branch graft 100 ofFIGS. 1 and 2 into the vasculature of a patient. Referring now to FIG.4, delivery system 400 includes a handle 402. An inner member 404extends distally from handle 402. Braided flange branch graft 100 islocated over a distal end 406 of inner member 404. Braided flange branchgraft 100 is partially cutaway in the view of FIG. 4 for clarity ofpresentation. As used herein, the proximal end of delivery system 400 isreferenced with respect to the operator's handle, i.e., handle 402,while the proximal end of braided flange branch graft 100 is referencedwith respect to the end closest to the heart via the length of bloodtraveled from the heart. (In this example the distal and proximal endsof each coincide.)

Inner member 404 is a hollow tubular member and includes a guide wirelumen. A guide wire 408 extends through the guide wire lumen of innermember 404.

Braided flange branch graft 100 is stretched into a substantiallycylindrical shape by delivery system 400 to minimize the deliveryprofile of braided flange branch graft 100. Further, braided flangebranch graft 100 is extremely flexible once stretched. Since braidedflange branch graft 100 has a small delivery profile and is extremelyflexible, braided flange branch graft 100 can be used in a wide varietyof applications.

In accordance with this example, braided flange branch graft 100 isconnected and stretched at inner end 118, neck 106, base 109, and outerend 120. More particularly, braided flange branch graft 100 is connectedto a neck hook 410 at neck 106. Neck hook 410 is fixed in position anddoesn't move relative to handle 402 in accordance with this example.Illustratively, neck hook 410 is mounted directly to inner member 404.After deployment of braided flange branch graft 100 as discussed furtherbelow, neck hook 410 is pulled from and releases braided flange branchgraft 100 as inner member 404 is retracted.

Braided flange branch graft 100 is connected to an inner end hook 412 atinner end 118. Inner end hook 412 is connected to an inner end hookslider 414 of handle 402 by an inner end hook connector 416, e.g., awire. Inner end hook slider 414 is threadedly connected to an inner endadjustment ring 418. Inner end adjustment ring 418 is rotated, e.g., bythe physician, thereby causing longitudinal translation of inner endhook slider 414. More particularly, rotation of inner end adjustmentring 418 causes proximal or distal motion (left or right motion in theview of FIG. 4) of inner end hook slider 414 depending upon thedirection of rotation of inner end adjustment ring 418.

Inner flange 102 is stretched into a cylindrical shape between inner endhook 412 and neck hook 410. Illustratively, inner end hook 412 is pulledproximally and towards handle 402 by inner end hook slider 414 throughinner end hook connector 416. By rotating inner end adjustment ring 418,inner end hook slider 414 is moved distally towards braided flangebranch graft 100. This releases the tension pulling on inner end hook412. Inner end hook 412, in turn, releases the tension on braided flangebranch graft 100 between inner end 118 and neck 106 thus allowing innerflange 102 to return to its relaxed shape, e.g., to the saucer shape ofinner flange 102. While only a single set of hooks (one for eachposition) is shown in the Figures, multiple hooks and/or sets of hooksmay be utilized in multiple radial directions to stabilize or distributethe forces at each axial (lateral) hook position with its respectivebraided engagement postion.

However, should the positioning of inner flange 102 be unsatisfactory,inner end adjustment ring 418 is rotated in the reverse direction. Thiscauses inner end hook slider 414 to move proximally away from braidedflange branch graft 100. This increases the tension pulling on inner endhook 412. Inner end hook 412, in turn, increases the tension on braidedflange branch graft 100 between inner end 118 and neck 106 thus causinginner flange 102 to return to its stretched shape, e.g., to thecylindrical shape of inner flange 102 shown in FIG. 4. Braided flangebranch graft 100 is then repositioned.

Once the positioning of inner flange 102 is satisfactory, continueddistal travel of inner end hook 412 causes inner end hook 412 to slipfrom and release braided flange branch graft 100 thus permanentlydeploying inner flange 102.

Braided flange branch graft 100 is connected to a base hook 420 at base109. Base hook 420 is connected to a base hook slider 422 of handle 402by a base hook connector 424, e.g., a pair of coaxial hypo tubes. Basehook slider 422 is threadedly connected to a base adjustment ring 426.

Base adjustment ring 426 is rotated, e.g., by the physician, therebycausing longitudinal translation of base hook slider 422. Moreparticularly, rotation of base adjustment ring 426 causes proximal ordistal motion (left or right motion in the view of FIG. 4) of base hookslider 422 depending upon the direction of rotation of base adjustmentring 426.

Outer flange 104 is stretched into a cylindrical shape between base hook420 and neck hook 410. Illustratively, base hook 420 is pushed distallyand away from handle 402 by base hook slider 422 through base hookconnector 424. By rotating base adjustment ring 426, base hook slider422 is moved proximally away from braided flange branch graft 100. Thisreleases the tension pushing on base hook 420. Base hook 420, in turn,releases the tension on braided flange branch graft 100 between base 109and neck 106 thus allowing outer flange 104 to return to its relaxedshape, e.g., to the saucer shape of outer flange 104.

However, should the positioning of outer flange 104 be unsatisfactory,base adjustment ring 426 is rotated in the reverse direction. Thiscauses base hook slider 422 to move distally towards braided flangebranch graft 100. This increases the tension pushing on base hook 420.Base hook 420, in turn, increases the tension on braided flange branchgraft 100 between base 109 and neck 106 thus causing outer flange 104 toreturn to its stretched shape, e.g., to the cylindrical shape of outerflange 104 shown in FIG. 4. Braided flange branch graft 100 is thenrepositioned.

Once the positioning of outer flange 104 is satisfactory, continuedproximal travel of base hook 420 causes base hook 420 to slip from andrelease braided flange branch graft 100 thus permanently deploying outerflange 104.

Braided flange branch graft 100 is connected to an outer end hook 428 atouter end 120. Outer end hook 428 is connected to an outer end hookslider 430 of handle 402 by an outer end hook connector 432, e.g., apair of coaxial hypo tubes. Outer end hook slider 430 is threadedlyconnected to an outer end adjustment ring 434.

Outer end adjustment ring 434 is rotated, e.g., by the physician,thereby causing longitudinal translation of outer end hook slider 430.More particularly, rotation of outer end adjustment ring 434 causesproximal or distal motion (left or right motion in the view of FIG. 4)of outer end hook slider 430 depending upon the direction of rotation ofouter end adjustment ring 434.

Trunk 108 is stretched into an elongated cylindrical shape between outerend hook 428 and neck hook 410 (or base hook 420). Illustratively, outerend hook 428 is pushed distally and away from handle 402 by outer endhook slider 430 through outer end hook connector 432. By rotating outerend adjustment ring 434, outer end hook slider 430 is moved proximallyaway from braided flange branch graft 100. This releases the tensionpushing on outer end hook 428. Outer end hook 428, in turn, releases thetension on braided flange branch graft 100 thus allowing trunk 108 toreturn to its relaxed shape, e.g., to a shorter greater diametercylinder.

However, should the positioning of trunk 108 be unsatisfactory, outerend adjustment ring 434 is rotated in the reverse direction. This causesouter end hook slider 430 to move distally towards braided flange branchgraft 100. This increases the tension pushing on outer end hook 428.Outer end hook 428, in turn, increases the tension on braided flangebranch graft 100 between outer end 120 and neck 106 (or base 109) thuscausing trunk 108 to return to its stretched shape, e.g., to theelongated cylindrical shape of trunk 108 shown in FIG. 4. Braided flangebranch graft 100 is then repositioned.

Once the positioning of trunk 108 is satisfactory, continued proximaltravel of outer end hook 428 causes outer end hook 428 to slip from andrelease braided flange branch graft 100 thus permanently deploying trunk108.

Although four points of attachment to braided flange branch graft 100for controlled deployment are set forth above, in other examples, onlytwo or three points of attachment are used. For example, only inner endhook 412 and outer end hook 428 are attached to braided flange branchgraft 100 and braided flange branch graft 100 is stretched between innerend hook 412 and outer end hook 428.

In another example, only inner end hook 412, neck hook 410, and outerend hook 428 are attached to braided flange branch graft 100. Inaccordance at this example, braided flange branch graft 100 is stretchedbetween inner end hook 412 and neck hook 410, and between neck hook 410and outer end hook 428. Further, other connection means can be usedother than hooks.

In yet another example, braided flange branch graft 100 is constrainedwithin a sheath of a delivery system. Retraction of the sheath exposesbraided flange branch graft 100, which self-expands and is permanentlydeployed.

FIG. 5 is a cross-sectional view of a vessel system 500 includingbraided flange branch graft 100 of FIGS. 1 and 2 in its stretched shapein accordance with one embodiment. Referring now to FIG. 5, a main stentgraft 502 is deployed within a main vessel 504 using any one of a numberof techniques well known to those of skill in the art. Illustratively,main stent graft 502 is deployed to exclude an aneurysm in main vessel504, main vessel 504 having a vessel wall 505.

A side opening 506 in a sidewall 508 of main stent graft 502 is alignedwith a branch vessel 510 emanating from main vessel 504. Braided flangebranch graft 100, in its stretched cylindrical shape, is insertedthrough side opening 506 and into branch vessel 510, for example, usingdelivery system 400 of FIG. 4. Since braided flange branch graft 100 hasa small delivery profile and is extremely flexible, braided flangebranch graft 100 can be used in a wide variety of applications, e.g., inthe case when branch vessel 510 is small and difficult to reach.

Neck 106 of braided flange branch graft 100 is positioned within sideopening 506 of main stent graft 502, for example, using a radiopaquemarker or other imaging technique.

FIG. 6 is a cross-sectional view of vessel system 500 of FIG. 5 at afurther stage during deployment of braided flange branch graft 100.Referring now to FIG. 6, inner flange 102 is deployed. Moreparticularly, inner flange 102 is return to its relaxed shape, e.g., toits saucer shape, as shown in FIG. 6. Illustratively, inner flange 102is deployed as discussed above in reference to delivery system 400 ofFIG. 4. Inner flange 102 is deployed inside of main stent graft 502.

FIG. 7 is a cross-sectional view of vessel system 500 of FIG. 6 at afurther stage during deployment of braided flange branch graft 100.Referring now to FIG. 7, outer flange 104 is deployed. Moreparticularly, outer flange 104 is return to its relaxed shape, e.g., toits saucer shape, as shown in FIG. 7. Illustratively, outer flange 104is deployed as discussed above in reference to delivery system 400 ofFIG. 4. Outer flange 104 is deployed outside of main stent graft 502 andbetween main stent graft 502 and vessel wall 505.

As shown in FIG. 7, inner flange 102 and outer flange 104 are deployedon opposite sides of sidewall 508 of main stent graft 502. Further,inner flange 102 and outer flange 104 have a first diameter D1 at outerradial perimeters 110,112, respectively, greater than a second diameterD3 of side opening 506. Thus, sidewall 508 of main stent graft 502 issandwiched between inner flange 102 and outer flange 104 mounting andsealing braided flange branch graft 100 to main stent graft 502. In oneexample, both inner flange 102 and outer flange 104 push on sidewall 508of main stent graft 502.

More particularly, sidewall 508 is located within annular channel 114defined by inner flange 102, neck 106, and outer flange 104 of braidedflange branch graft 100. Stated another way, inner flange 102, neck 106,and outer flange 104 form a locking mechanism, sometimes called a meansfor locking, for locking braided flange branch graft 100 to main stentgraft 502.

In this manner, braided flange branch graft 100 is securely mounted tomain stent graft 502 forming an intra-vascular assembly. The connectionbetween braided flange branch graft 100 and main stent graft 502 isachieved by simply and reliably deploying inner flange 102 and outerflange 104 on opposite sides of sidewall 508 of main stent graft 502.

FIG. 8 is a cross-sectional view of vessel system 500 of FIG. 7 at afurther stage during deployment of braided flange branch graft 100.Referring now to FIG. 8, trunk 108 is deployed. More particularly, trunk108 is return to its relaxed shape, e.g., to its shorter larger diametercylindrical shape, as shown in FIG. 8. Illustratively, trunk 108 isdeployed as discussed above in reference to delivery system 400 of FIG.4.

Trunk 108 is deployed inside of branch vessel 510. In one example, trunk108 self-expands into branch vessel 510 to maintain patency of branchvessel 510. Once braided flange branch graft 100 is deployed, fluid,e.g., blood, passes through lumen 116 of braided flange branch graft100, e.g., from the lumen defined by main stent graft 502 into branchvessel 510. More particularly, lumen 116 of braided flange branch graft100 is in fluid communication with the lumen of main stent graft 502.Main stent graft 502 and braided flange branch graft 100 collectivelyform an intra-vascular assembly 802.

Although deployment of inner flange 102 before the deployment of outerflange 104 is set forth, in another example, outer flange 104 isinitially deployed and then inner flange 102 is deployed. In yet anotherexample, both inner flange 102 and outer flange 104 are deployedsimultaneously.

This disclosure provides exemplary embodiments. The scope is not limitedby these exemplary embodiments. Numerous variations, whether explicitlyprovided for by the specification or implied by the specification ornot, such as variations in structure, dimension, type of material andmanufacturing process may be implemented by one of skill in the art inview of this disclosure.

1. An assembly comprising a braided flange branch graft around a tubularopening, said braided flange branch graft formed from a braided superelastic memory material, said braided flange branch graft comprising: afirst flange; a second flange; a neck between said first flange and saidsecond flange; and a trunk extending longitudinally from said secondflange; wherein said tubular opening is the beginning of a substantiallyunobstructed passageway through and substantially along an axis of thebraided flange.
 2. The assembly of claim 1 wherein said first flange andsaid second flange extend radial outward from said neck.
 3. The assemblyof claim 1 wherein said first flange and said second flange have a firstdiameter greater than a second diameter of said neck.
 4. The assembly ofclaim 1 wherein said first flange, said second flange, and said neckcollectively define an annular channel.
 5. The assembly of claim 1wherein said first flange is disk shaped.
 6. The assembly of claim 5wherein said first flange comprises an outer radial perimeter that iscircular.
 7. The assembly of claim 5 wherein said first flange increasesin thickness towards a radial center of said first flange.
 8. Theassembly of claim 5 wherein said first flange has a uniform thickness.9. The assembly of claim 5 wherein said second flange is disk shaped.10. The assembly of claim 1 wherein said trunk comprises a base attachedto said second flange.
 11. The assembly of claim 1 wherein said trunk iscylindrical.
 12. The assembly of claim 1 wherein said braided flangebranch graft defines a lumen extending through said braided flangebranch graft.
 13. The assembly of claim 1 wherein said braided flangebranch graft further comprises an elastic cover over said braided superelastic memory material.
 14. An assembly comprising: a main stent graftcomprising a sidewall with a side opening therein; and a braided flangebranch graft connected to said main stent graft, said braided flangebranch graft formed from a braided super elastic memory material, saidbraided flange branch graft elements comprising: a first flange on aninside of said main stent graft; a second flange on an outside of saidmain stent graft; a neck between said first flange and said secondflange, said neck being located in said side opening; and a trunkextending longitudinally from said second flange, where a substantiallyunobstructed side passage provides fluid communication through saidbraided flange elements through said side opening.
 15. The assembly ofclaim 14 wherein said sidewall is sandwiched between said first flangeand said second flange.
 16. The assembly of claim 14 wherein said firstflange and said second flange are deployed on opposite sides of saidsidewall of said main stent graft.
 17. The assembly of claim 14 whereinsaid first flange and said second flange have a first diameter greaterthan a second diameter of said side opening.
 18. The assembly of claim14 wherein said sidewall is located within an annular channel defined bysaid first flange, said neck, and said second flange.
 19. The assemblyof claim 14 wherein said first flange, said neck, and said second flangeform a means for locking said braided flange branch graft to said mainstent graft.
 20. The assembly of claim 14 wherein said braided flangebranch graft defines a lumen in fluid communication with a lumen of saidmain stent graft.
 21. A delivery system comprising: a braided flangebranch graft formed from a braided super elastic memory material, saidbraided flange branch graft comprising: a first flange; a second flange;a neck between said first flange and said second flange; and a trunkextending longitudinally from said second flange, said braided flangebranch graft being stretched into a substantially cylindrical shape; ahandle; an inner member extending distally from said handle, saidbraided flange branch graft being located over a distal end of saidinner member; a neck hook connected to said neck of said braided flangebranch graft; an inner end hook connected to an inner end of saidbraided flange branch graft, said first flange being stretched betweensaid inner end hook and said neck hook; and a base hook connected to abase of said trunk, said second flange being stretched between said neckhook and said base hook.
 22. The delivery system of claim 21 whereinsaid handle comprises: an inner end hook slider connected to said innerend hook by an inner end hook connector; and a base hook sliderconnected to said base hook by a base hook connector.
 23. The deliverysystem of claim 22 wherein said handle further comprises: an inner endadjustment ring threadedly connected to said inner end hook slider; anda base adjustment ring threadedly connected to said base hook slider.24. The delivery system of claim 22 wherein said inner end hookconnector comprises a wire.
 25. The delivery system of claim 22 whereinsaid base hook connector comprises a pair of coaxial hypo tubes.
 26. Thedelivery system of claim 21 wherein said neck hook is connected to saidinner member.
 27. The delivery system of claim 21 wherein said innermember defines a guide wire lumen, said delivery system furthercomprising a guide wire in said guide wire lumen.
 28. The deliverysystem of claim 21 further comprising an outer end hook connected to anouter end of said braided flange branch graft, said outer end hookstretching said trunk.
 29. The delivery system of claim 28 wherein saidhandle comprises: an outer end hook slider connected to said outer endhook by an outer end hook connector; and an outer end adjustment ringthreadedly connected to said outer end hook slider.
 30. A method offorming an intra-vascular assembly comprising: deploying a main stentgraft comprising a sidewall having a side opening therein; stretching abraided flange branch graft into a substantially cylindrical shape, saidbraided flange branch graft formed from a braided super elastic memorymaterial, said braided flange branch graft element comprising: a firstflange; a second flange; a neck between said first flange and saidsecond flange; and a trunk extending longitudinally from said secondflange, where a substantially unobstructed passage for fluidcommunication is provided through said braided flange element;positioning said neck within said side opening; deploying said firstflange inside of said main stent graft; and deploying said second flangeoutside of said main stent graft, wherein said sidewall of said mainstent graft is sandwiched between said first flange and said secondflange.
 31. The method of claim 30 further comprising deploying saidtrunk.